Raheel Rizwan1, Farhan Zafar2, Roosevelt Bryant2, James S Tweddell2, Angela Lorts3, Clifford Chin3, David L Morales2. 1. Department of Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: raheel.rizwan@cchmc.org. 2. Department of Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 3. Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Abstract
BACKGROUND: Waitlist mortality is more than 12% for pediatric heart transplantation, with strikingly high rates of organ refusal, many of which are due to donor quality. However, some centers use these organs despite refusals by other centers for donor quality. We hypothesize that the number of refusals for donor quality (RDQ) does not affect pediatric heart transplantation outcomes. METHODS: Pediatric heart transplants from 2000 to 2015 were identified using the United Network for Organ Sharing database and were matched against the potential transplant recipients dataset with donor refusal codes. Refusals for donor quality were counted for each organ. The population was divided into two groups: RDQ-low (0 to 3 RDQs, n = 3,404) and RDQ-high (>3 RDQs, n = 1,585). Posttransplant outcomes of both cohorts were analyzed. RESULTS: Of 4,989 pediatric heart transplants, 75% (n = 3,770) had 1 or more RDQ (median 3 RDQ; interquartile range, 1 to 7). The RDQ-lower group (0 to 3 RDQs) and the RDQ-higher group (>3 RDQ) had similar posttransplant survival (p = 0.41) and freedom from retransplantation (p = 0.37). Both groups had similar posttransplant survival even for high-risk recipient cohorts: adolescents (p = 0.06), congenital heart disease (p = 0.87), retransplantation (p = 0.47), extracorporeal membrane oxygenation (p = 0.61), mechanical ventilation (p = 0.24), and poor renal function at transplant (p = 0.46). In addition, recipient subgroups who had donors with increasing number of RDQ (>6, >9, >12, and >15 RDQ) also had similar posttransplant survival compared with the RDQ-low group (p = 0.63, p = 0.62, p = 0.92, and p = 0.50, respectively). CONCLUSIONS: The outcome of pediatric heart transplantation is not affected by the number of RDQ, even for high-risk recipients. The use and interpretation of donor quality refusal code should be considered carefully while selecting or refusing donors in this era of supply and demand mismatch.
BACKGROUND: Waitlist mortality is more than 12% for pediatric heart transplantation, with strikingly high rates of organ refusal, many of which are due to donor quality. However, some centers use these organs despite refusals by other centers for donor quality. We hypothesize that the number of refusals for donor quality (RDQ) does not affect pediatric heart transplantation outcomes. METHODS: Pediatric heart transplants from 2000 to 2015 were identified using the United Network for Organ Sharing database and were matched against the potential transplant recipients dataset with donor refusal codes. Refusals for donor quality were counted for each organ. The population was divided into two groups: RDQ-low (0 to 3 RDQs, n = 3,404) and RDQ-high (>3 RDQs, n = 1,585). Posttransplant outcomes of both cohorts were analyzed. RESULTS: Of 4,989 pediatric heart transplants, 75% (n = 3,770) had 1 or more RDQ (median 3 RDQ; interquartile range, 1 to 7). The RDQ-lower group (0 to 3 RDQs) and the RDQ-higher group (>3 RDQ) had similar posttransplant survival (p = 0.41) and freedom from retransplantation (p = 0.37). Both groups had similar posttransplant survival even for high-risk recipient cohorts: adolescents (p = 0.06), congenital heart disease (p = 0.87), retransplantation (p = 0.47), extracorporeal membrane oxygenation (p = 0.61), mechanical ventilation (p = 0.24), and poor renal function at transplant (p = 0.46). In addition, recipient subgroups who had donors with increasing number of RDQ (>6, >9, >12, and >15 RDQ) also had similar posttransplant survival compared with the RDQ-low group (p = 0.63, p = 0.62, p = 0.92, and p = 0.50, respectively). CONCLUSIONS: The outcome of pediatric heart transplantation is not affected by the number of RDQ, even for high-risk recipients. The use and interpretation of donor quality refusal code should be considered carefully while selecting or refusing donors in this era of supply and demand mismatch.
Authors: Nicholas A Szugye; David L S Morales; Angela Lorts; Farhan Zafar; Ryan A Moore Journal: J Heart Lung Transplant Date: 2021-08-27 Impact factor: 10.247
Authors: Alia Dani; Justin S Heidel; Tingting Qiu; Yin Zhang; Yizhao Ni; Md Monir Hossain; Clifford Chin; David L S Morales; Bin Huang; Farhan Zafar Journal: Pediatr Transplant Date: 2021-12-08
Authors: Nicholas A Szugye; Farhan Zafar; Nicholas J Ollberding; Chet Villa; Angela Lorts; Michael D Taylor; David L S Morales; Ryan A Moore Journal: J Heart Lung Transplant Date: 2020-12-04 Impact factor: 10.247
Authors: Michael O Harhay; Raphaël Porcher; Gabriel Thabut; Michael J Crowther; Thomas DiSanto; Samantha Rubin; Zachary Penfil; Zhou Bing; Jason D Christie; Joshua M Diamond; Edward Cantu Journal: Ann Am Thorac Soc Date: 2019-03